Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear

Bacterial vaginosis, cervical Human Papillomavirus infection and cervical cytological abnormalities in adult women in Central Brazil: a cross-sectional study / Vaginose bacteriana, infecção cervical pelo Papilomavírus humano e anormalidades citológicas cervicais em mulheres adultas no Brasil Central: um estudo transversal

Bacterial vaginosis is the most common cause of vaginal discharge and occurs when there is an imbalance in the vaginal microbiota, predominantly composed of Lactobacillus spp. Human Papillomavirus is the most common sexually transmitted virus in the world. Persistent infection with high-risk Human Papillomavirus genotypes is the main cause of the development of cervical intraepithelial neoplasia and cervical cancer. Objective: To investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection and between bacterial vaginosis and cervical cytological abnormalities in adult women. Methods: Cross-sectional study carried out in a gynecology outpatient clinic of the public health network. A total of 202 women were included in the study and underwent gynecological examination with cervical specimen collection. Cervical cytopathological examinations and bacterioscopy by the Nugent method were performed to identify bacterial vaginosis, and PCR and reverse hybridization were carried out for Human Papillomavirus detection and genotyping. Bivariate analysis was performed to investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection, and between bacterial vaginosis and cervical cytological abnormalities. The odds ratio was calculated, with the respective 95% confidence intervals (95%CI) and 5% significance level (p≤0.05). Results: The prevalence of bacterial vaginosis was 33.2% (67/202), the prevalence of cervical Human Papillomavirus infection was 38.6% (78/202) and the prevalence of cervical cytological abnormalities was 6.0% (12/202). Bivariate analysis showed no significant association between bacterial vaginosis and cervical Human Papillomavirus infection (OR 0.69; 95% CI 0.37­ 1.27; p=0.23), or between bacterial vaginosis and cervical cytological abnormalities (OR 0.65; 95%CI 0.17­2.50; p=0.54). Conclusion: In this study, bacterial vaginosis did not represent a risk factor for cervical Human Papillomavirus infection or for the presence of cervical cytological abnormalities in the investigated adult women.

A vaginose bacteriana é a causa mais comum de corrimento vaginal e ocorre quando há um desequilíbrio da microbiota vaginal, composta predominantemente de Lactobacillus spp. O papilomavírus humano é o vírus sexualmente transmissível mais comum no mundo. A infecção persistente com genótipos do papilomavírus humano de alto risco é a principal causa do desenvolvimento de neoplasias intraepiteliais cervicais e câncer de colo do útero. Objetivo: Investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais em mulheres adultas. Métodos: Estudo de corte transversal realizado em um ambulatório de ginecologia da rede pública de saúde. O total de 202 mulheres foi incluído no estudo e submetido ao exame ginecológico com coleta de espécime cervical. Foram realizados os exames citopatológicos cervicais, a bacterioscopia pelo método de Nugent para a identificação da vaginose bacteriana e reação em cadeia da polimerase e hibridização reversa para a detecção e genotipagem do papilomavírus humano. Análise bivariada foi realizada para investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais. Foi calculado o odds ratio, com os respectivos intervalos de confiança de 95% (IC95%) e nível de significância de 5% (p≤0,05). Resultados: A prevalência da vaginose bacteriana foi de 33,2% (67/202), a da infecção cervical pelo papilomavírus humano foi de 38,6% (78/202) e a de anormalidades citológicas cervicais foi de 6,0% (12/202). A análise bivariada não demonstrou associação significativa entre vaginose bacteriana e infecção cervical pelo papilomavírus humano (OR 0,69; IC95% 0,37­1,27; p=0,23), nem entre vaginose bacteriana e anormalidades citológicas cervicais (OR 0,65; IC95% 0,17­2,50; p=0,54). Conclusão: Neste estudo a vaginose bacteriana não representou um fator de risco para a infecção cervical pelo papilomavírus humano e nem para presença de anormalidades citológicas cervicais nas mulheres adultas investigadas

Evaluation of breastfeeding self-effectiveness and its associated factors in puerperal women assisted at a public health system in Brazil / Avaliação da autoeficácia para amamentação e seus fatores associados em puérperas assistidas no sistema público de saúde no Brasil

Abstract Objectives: evaluate breastfeeding self-efficacy and its associated factors in puerperal women assisted at a public health system in Brazil. Methods: it is a cross-sectional analytical study, with convenience sampling and two instruments: sociodemographic, personal and clinical, and Breastfeeding Self-Efficacy Scale (BSES-SF), applied to puerperal women in a puerperal outpatient clinic at two public maternity hospitals in Goiânia/GO, from September to November 2019. Inclusion criteria: mothers in puerperal period, age above 18 years, children born at term and on exclusive breastfeeding. Exclusion criteria: report depression and premature wean. Results: 128puerperal women were interviewed. The average age was 26.7 (± 5.9) years old. The levels of self-efficacy were high (95.3%) and no puerperal had a low level. The variables with statistical significance were: experience in breastfeeding (p= 0.0312), not having received information on breastfeeding during pregnancy (p=0.0292), did not receive other milk at the maternity (p=0.0380), did not feel pain while breastfeeding (p=0.0242), being able to breastfeed on demand (p=0.0124), presence of breast engorgement (p=0.0207), presenting protruding nipples (p=0.0427). Conclusions: clinical and personal aspects were identified as risk factors for early weaning. This can provide information for the training ofprofessionals and structuring the interventions in health services, with a view in preventing these risks.

Resumo Objetivos: avaliar a autoeficácia da amamentação e seus fatores associados em puérperas atendidas no sistema público de saúde. Métodos: estudo transversal analítico, com amostragem por conveniência e dois instrumentos: sociodemográfico, pessoal e clínico, e Escala de Autoeficácia em Amamentação, aplicada a puérperas em um ambulatório de acompanhamento puerperal de duas maternidades públicas de Goiânia/GO, de setembro a novembro de 2019. Critérios de inclusão: mães no período puerperal, idade acima de 18 anos, filhos nascidos a termo e em aleitamento materno exclusivo. Critérios de exclusão: autorrelato de depressão e desmame prematuro. Resultados: foram entrevistadas 128 puérperas. A média de idade foi de 26,7 (± 5,9). Os níveis de autoeficácia foram altos (95,3%) e nenhuma puérpera obteve nível baixo. As variáveis com significância estatística foram: experiência em amamentar (p = 0,0312), não ter recebido informações sobre aleitamento materno durante a gravidez (p = 0,0292), não ter recebido outro leite na maternidade (p = 0,0380), não sentindo dor durante a amamentação (p = 0,0242), sendo amamentada sob demanda (p = 0,0124), presença de ingurgitamento mamário (p = 0,0207), apresentando mamilos salientes (p = 0,0427). Conclusões: foram identificados aspectos clínicos e pessoais como fatores de risco para o desmame precoce. Isso pode fornecer informações para a formação de profissionais e a estruturação de intervenções nos serviços de saúde, visando a prevenção desses riscos.

Tissue micro-RNAs associated with colorectal cancer prognosis: a systematic review.

Colorectal cancer (CRC) is a multifactorial disease commonly diagnosed worldwide, with high mortality rates. Several studies demonstrate important associations between differential expression of micro-RNAs (miRs) and the prognosis of CRC. The present study aimed to identify differentially expressed tissue miRs associated with prognostic factors in CRC patients, through a systematic review of the Literature. Using the PubMed database, Cochrane Library and Web of Science, studies published in English evaluating miRs differentially expressed in tumor tissue and significantly associated with the prognostic aspects of CRC were selected. All the included studies used RT-PCR (Taqman or SYBR Green) for miR expression analysis and the period of publication was from 2009 to 2018. A total of 115 articles accomplished the inclusion criteria and were included in the review. The studies investigated the expression of 100 different miRs associated with prognostic aspects in colorectal cancer patients. The most frequent oncogenic miRs investigated were miR-21, miR-181a, miR-182, miR-183, miR-210 and miR-224 and the hyperexpression of these miRs was associated with distant metastasis, lymph node metastasis and worse survival in patients with CRC. The most frequent tumor suppressor miRs were miR-126, miR-199b and miR-22 and the hypoexpression of these miRs was associated with distant metastasis, worse prognosis and a higher risk of disease relapse (worse disease-free survival). Specific tissue miRs are shown to be promising prognostic biomarkers in patients with CRC, given their strong association with the prognostic aspects of these tumors, however, new studies are necessary to establish the sensibility and specificity of the individual miRs in order to use them in clinical practice.

Human papillomavirus (HPV) genotype distribution in penile carcinoma: Association with clinic pathological factors.

BACKGROUND: Penile carcinoma (PC) is a rare, highly mutilating disease, common in developing countries. The evolution of penile cancer includes at least two independent carcinogenic pathways, related or unrelated to HPV infection. OBJECTIVES: To estimate the prevalence, identify HPV genotypes, and correlate with clinicopathological data on penile cancer. METHODS: A retrospective cohort study involving 183 patients with PC undergoing treatment in a referral hospital in Goiânia, Goiás, in Midwestern Brazil, from 2003 to 2015. Samples containing paraffin embedded tumor fragments were subjected to detection and genotyping by INNO-LiPA HPV. The clinicopathological variables were subjected to analysis with respect to HPV positivity and used prevalence ratio (PR), adjusted prevalence ratio (PRa) and 95% confidence interval (CI) as statistical measures. RESULTS: The prevalence of HPV DNA in PC was 30.6% (95% CI: 24.4 to 37.6), high-risk HPV 24.9% (95% CI: 18.9 to 31.3), and 62.5% were HPV 16. There was a statistical association between the endpoints HPV infection and HPV high risk, and the variable tumor grade II-III (p = 0.025) (p = 0.040), respectively. There was no statistical difference in disease specific survival at 10 years between the HPV positive and negative patients (p = 0.143), and high and low risk HPV (p = 0.325). CONCLUSIONS: The prevalence of HPV infection was 30.6%, and 80.3% of the genotypes were identified as preventable by anti-HPV quadrivalent or nonavalent vaccine. HPV infections and high-risk HPV were not associated with penile carcinoma prognosis in this study.